Objective To investigate the impact of minimally invasive osteosynthesis (MIPO)combined with locking plate fixation for the prognosis of patients with fractures of the tibia and Pilon.Methods 84 patients with CT or X -ray diagnosis of tibial Pilon fracture were randomly divided into group A (n =42)and group B (n =42). The group A were threatment with MIPO combination locking plate fixation and group B were threatment with reduction and internal fixation.The following -up clinical and radiological data of the two groups were compared. Results The blood loss of group A were less than group B(t =8.963,P <0.05),postoperative pain score were lower than group B(t =10.789,P <0.05),while the satisfaction score was higher than group A (t =8.963,P <0.05), postoperative hospital stay,healing time were shorter than group B (t =9.362,10.556,all P <0.05).The Conroy scoring system and Tenny scoring system of A group of excellent rates were 95.24%,76.19% were higher than 92.86% and 71.43% of group B(χ2 =6.222,6.574,all P <0.05).The overall complication rate of A group was lower than the group B(χ2 =7.265,P <0.05 ).Conclusion MIPO combination of locking plate fixation Pilon fractures can reduce soft tissue dissection,reduce surgical trauma to the patient,reduce postoperative complications in patients,in favor of patients recover as soon as possible.

Objective To revise the American College of Rheumatology classification criteria for rheumatoid arthritis(RA)with anti-cyclic citrullinated peptide(anti-CCP)antibodies and to evaluate its utility in the diagnosis of Chinese patients.Methods All patients from the Department of Rheumatology and Immunology of Peking University People's Hospital who had arthritis complaints in recent two years were enrolled.Patients were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The diagnostic value of ACR criteria and the anti-CCP revised criteria(RA-6,RA-7 and RA-8)were evaluated by analyzing the clinical and laboratory parameters.Results A total of 604 patients were included in the study.312 patients were diagnosed as RA and 292 were diagnosed as other rheumatic diseases by rheumatologists.For those patients who had disease course for less than 2 years,the sensitivity of 1987 ACR criteria,RA-6,RA-7 and RA-8 criteria was 82.0%,91.0%.87.0%and 87.0%,respectively.The specificity of them was 95.6%,83.9%,95.6%and 95.6%.respectively.The sensitivity of 1987 ACR criteria,RA-6,RA-7 and RA-8 criteria for all the RA patients was 92.3%,96.8%.94.6%and 94.6%,respectively.The speciflcity of them was 92.8%,83.6%,92.8%and 92.8%.respectively.Conclusion The 1987 ACR criteria have high sensitivity and specificity in established RA.but its sensitivity in early RA is low.The RA-6criteria can improve the sensitivity dramatically but with reduced specificity.The RA-7 criteria can increase the sensitivity without sacrifice the specificity,especially in early RA patients.It may be used as a new set of classification criteria in clinical practice.

Objective To immunize BALB/c mice with type 3 musearinic acetylcholine receptor polypeptide (M3RP) and to evaluate the role of M3RP in SS. Methods Four-week-old BALB/e mice were immunized with M3R polypeptide 213-228 (M3RP) on days 0, 14, 35, 56, and were re-immuniged on days 65, 84, 105, and one mouse was killed every 2 to 3 weeks. The mice of the control group were immunized with submaxillary gland homogenate, GST, and PBS. The animals were analyzed for the presence of anti-SSA,anti-SSB, RF, ANA, anti-a-fodrin and anti-M3RP in sera by immunofluorescenee or ELISA. The cytokines of IFN-γ IL-2 and IL-10 were measured with ELISA. Salivary glands were examined by H＆E staining and immunohistochemical analysis. Volume of water drinking by each groups were calculated. Results BALB/e mice immunized with M3RP and submaxillary gland homogenate developed an immune response directed against M3RP, α-fodrin and ANA, but no antibodies against SSA, SSB and RF were found. Furthermore, lym-phocytic infiltrates in the salivary glands of immunized animals were observed 50 days after first immunization of M3RP and submaxillary gland homogenate. The serum IFN-α in mice of M3RP, submaxillary gland ho-mogenate, GST and PBS was (62±6), (89±5), (30±5) and (19±6) pg/ml respectively, and IL-2 was (12.6±1.6), (19.8±0.4), (3.9±0.9), and (4.9±1.1) pg/ml respectively (P<0.05). No difference was found in the level of serum IL-10 among the four group. Expression of α-fodrin was found only in submaxillary gland in M3RP and submaxillary gland homogenate groups of mice, but not in PBS and GST controls when studied by immunohistochemical analysis. Conclusion These results suggest that BALB/c mice immunized with M3RP are reminiscent of human SS, and M3RP as an autoantigen participates the development of SS.

Objective To study the relationship between elevated serum level of immunoglobulin A (IgA) and other abnormality in immunological parameters in patients with primary Sjogren's syndrome (pSS)and those with viscera involvement based on determinations of serologic,other laboratory and clinical features.Methods Serum IgA level of 108 patients with pSS,seven males and 101 females with an age of 30～78 years and length of disease course of 0.2～20.0 years,was detected by turbidimetry.Clinical and laboratory parameters in patients were compared between different groups.Remits Elevated serum IgA level was found in 48 (44.4%) of 108 patients with pSS.Elevated erythrocyte sedimentation rate(ESR) was found in 91.7 percent of those with elevated sertum IgA and 63.3 percent in those with normal IgA(P<0.05).Serum positivity of rheumatoid factor(RF) was significantly higher in those with elevated serum IgA (70.8%)than those with normal IgA (48.3%,P<0.05).Pulmonary interstitial fibrosis could be found in 22.9 percent of those with elevated serum IgA,and in 8.3 percent of those with normal IgA(P<0.05).Occurrences of primary biliary cirrhosis and autoimmune hepatitis were higher in those with elevated serum IgA than in those with normal IgA,but not reaching statistical significance.Conclusion Serum IgA level misht play an important role in occurrence and development of pSS,and could be used as an indicator reflecting activity and severity of the disease,as well.

Objective To assess the safety and feasibility of hybrid trans-gastric endoscopic and laparoscopic cholecystectomy in a porcine model.Methods A total of 6 pigs underwent hybrid trans-gastric endoscopic and laparoscopic cholecystectomy from July to October,2010 under general anesthesia.The operation time and complications during the procedure were recorded,as well as post-operative changes of eating habits and weight.Animals underwent autopsies on post-operative days(POD)14 for evaluation of infection,abscesses and adhesion.Results All procedures were successfully performed and all dogs survived.There was no severe complication except for hemorrhage in one porcine,which was successfully managed under laparoscopy.The mean operation time was 87mins(ranging from 69-124 mins).After the operation,there was no change in eating habits or weight.At autopsy on POD 14,no abscess or hemorrhage was found.Sites of gastric closure were found to be completely healed.Conclusion The hybrid approach increases the safety of initial gastric puncture and gastric wall incision,simplifies peroral trans-gastric cholecystectomy,and decreases invasiveness of laparoscopic surgery.It is a bridge between laparoscopic and transluminal surgery.

Objective To analyze the suspicious results of serum HBV DNA by fluorescence quantitative PCR and develop appropriate countermeasures in order to improve the quality of detection of HBV DNA.Methods Blood samples of patients from the First Affiliated Hospital of Wenzhou Medical College from 2008 to 2011 were analyzed for HBV DNA by fluorescence quantitative PCR.1969 cases of suspicious results,judged by the rule of review the results of serum HBV DNA combined with the historical results,PCR amplification curve,HBV serum markers and clinical diagnosis,were analyzed and redetected by using of two different reagents,careHBV PCR Kit and careHBV PCR Kit V2,at the same time.The consistency and inconsistency ratio of the results were evaluated.Both the reasons of inconsistent and the undetected rates of careHBV PCR Kit were analyzed.The two reasons for the inconsistent results included the reagent related factors,e.g,showing no amplification curve caused by the false negative and abnormal low efficiency of amplification curve,and the non reagent related factors such as operating pollution and other sample factors.Results There were 115 154 blood samples were detected for HBV from 2008 to 2011 and 1969 samples (1.71％) with suspicious results were redetected.The consistency and inconsistency results were 1588 (80.65％) and 381 (19.35％),respectively.Every year from 2008 to 2011,the percentage of the inconsistent results caused by the reagent related factors were 18.87％,20.23％,51.33％ and 59.57％ respectively,which showed an increasing trend,and the percentage of inconsistent results caused by the nonreagent related factors were 81.13％,79.77％,48.67％ and 40.43％ respectively,which showed a declining trend year by year.The undetected rates of careHBV PCR Kit were 2.49％,4.08％,10.09％ and 14.47％ respectively,showing an increasing trend.Conclusions The redetection for the specimens with the suspicious results by using of different reagents can avoid the blind detection of HBV DNA and reduce the experimental error.All the clinical samples for quantitative HBV DNA including the mutations of HBV gene can be measured accurately and effectively,which is helpful to hepatitis B patients for antiviral therapy.

Objective To investigate the prevalence of human papillomavirus(HPV)infections in women with uterine cervical cancer in Wenzhou.Methods Exfoliated cells samples of cervix uteri were collected from 198 patients with cervical cancer. Flow-through hybridization technique was used to detect HPV and its genotypes.The relationship of HPV infection with cervical cancer stage,histological type and differentiation degree were analyzed.The prevalence of HPV infections in patients with different cervical diseases was observed.SPSS 13.0 was used for statistical analysis.Results In 198 patients with cervical cancer,HPV infection was occunrred in 147 (74.24%), of whom 101patients were superinfected (51.01%),and 129 patients(65.15%)were infected with the high-risk HPVs,which were significantly higher than those in cervicitis and cervical dysplasia(x2 = 28.28,65.34 and 95.22,P ＜ 0.01).HPV positive rate was not correlated with clinical stages,differentiation degree of cervical cancer(x2 = 0.475 and 0.969,P＞0.05).HPV positive rates in squamous cancer and adenocarcinoma had no statistical difference (x2 =0.582,P＞0.05).The logistic regression analysis showed that HPV 16/58 infection and age over 40might increase the risk of carcinogenesis of the cervix.Conclusion sHPV infection and superinfection are popular in women with cervix cancer in Wenzhou.HPV16/58 infection and age over 40 years are the risk factors of cervical cancer.

Objective To clarify the relation between the expression of Foxp3 in peripheral blood and plasma transforming growth factor betal (TGF-β1) and the activity of systemic lupus erythematosus (SLE). Methods Foxp3 mRNA expression of 28 active SLE patients, 13 inactive SLE patients and 16 healthy controls was determined by polymerase chain reaction. Active SLE patients were followed up; Foxp3 mRNA expression of 20 active patients was measured in the stable status and the plasma TGF-β1 was measured by ELISA in the active and stable status. Results The active SLE patients showed reduced levels of Foxp3 mRNA than the inactive SLE patients (P<0.01) and the healthy controls(P<0.01). Expression of Foxp3 mRNA and the plasma level of TGF-β1 in 20 SLE patients were both higher in stable status than in active status, Conclusion The expressions of Foxp3 mRNA in peripheral blood and TGF-β1 in plasma has significant inverse corelation with disease activity, which suggests that regulatory T cells may play an important role in the pathogenesis of SLE.

Objective Antibodies against citrulline-containing peptides such as anti-perinuclear factor (APF), anti-keratin antibodies (AKA), anti-filaggrin antibodies (AFA) and anti-cyclic citruilinated peptide (CCP) antibodies are very specific in RA. In recent years, detection of APF, AKA and anti-CCP antibodies have been widely used in clinical practice. Studies on the combined detection of these ACPA in diagnosing RA are limited in number. The aim of this study is to detect combined examination of APF, AKA, and anti-CCP antibodies and compare their values in the diagnosis of rheumatoid arthritis. The significance of combined detection of these ACPAs in rheumatoid arthritis is also investigated. Methods Five hunndred and fifly-one patients who suffered from arthritic problems during the recent two years were selected from the Department of Rheumatology and Immunology of Peking University People's Hospital. 304 of the patients were RA and 247 were diagnosed to have other rheumatic diseases based on the corresponding classification criteria. AKA and APF were tested by indirect immunofluorescence assay. Anti-CCP antibodies were tested antibodies, AKA and APF tests for RA were 76.2%, 43.6%, and 34.5%, respectively, and the specificities were highest specificity (100%), but it had a rather low sensitivity (28.3%). When two of the three ACPA were positive, the sensitivity and specificity for the diagnosis of RA was 48.4% and 99.2%, respectively. When either anti-CCP antibodies, AKA, or APF was treated as an individual parameter, the sensitivity was slightly increased (77.3%). However, the specificity decreased to 94.7%. Conclusion Anti-CCP antibodies are the most helpful makers for the diagnosis of rheumatoid arthritis among the three ACPAs which are used in clinical practice. The combined detection of anti-CCP antibodies, AKA, and APF cannot increase the diagnostic sensitivity and specificity of rheumaotid arthritis.

The systematic approaches of metabonomics are similar to the essential attribution in concept of the wholism for traditional Chinese medicine (TCM) theories. The metabonomics had been progressively utilized to study the TCM theories, such as "ZHENG" (synelromes), or the systematic mechanism of Chinese materia medica (CMM) and its formulae by animal models, and toxicology in recent years. These studies almost focused on the responeses of endogenous metabonome to biological stimuli or genetic manipulation (pharmacodynamics and toxicology) by TCM theory of "ZHENG", while less involved the precess of formulae itself and its dynamic changes (pharmacokinetics) by TCM theory of "FANG". The "treatment by differentiating syndrome" and "Correspondence of FANG-ZHANG" is the quintessence of TCM theories. Consequently, in this idea, the application of PK-PD methods based on metabonomics and "FANG-ZHENG correspondence" to investigating the compatibility of the formulae in TCM theory is discussed in this paper.